A Medicare Fix for Everyone

Statement

A Medicare Fix for Everyone

The U.S. Senate finally put partisan politics aside and recognized our responsibility to our nation's seniors and military families through passage of the bipartisan Medicare Improvements for Patients and Providers Act. This bill provides critical support for our health care providers in rural Arkansas, improves care and access for low-income Medicare beneficiaries, and makes much-needed reforms to Medicare Advantage programs.

The final bill was a hard fought compromise that initially failed by one vote because of the Republican leadership's insistence on putting President Bush's agenda and insurance companies' profits ahead of the needs of millions of seniors and military families. Faced with a deadline to pass this compromise shortly before the Fourth of July recess, the Senate went home without a new bill.

As a result, physicians faced the possibility of a 10.6 percent cut in fees for seeing Medicare patients and would have been forced to severely reduce the number of seniors that they can treat. This would have also affected military families who use TRICARE—the Department of Defense's health care program for service members and their families. TRICARE provider rates are tied to Medicare rates.

Now that the Senate has done its part, it is up to President Bush to sign this bill into law so that we may avert cuts to the physician fee schedule and other critical Medicare programs.

Included in this bill is the extension of certain provisions set to expire. One of these provides necessary rehabilitation and therapy services for some seniors who suffer a major injury—such as a fall—if they have exhausted their therapy benefits. These therapy caps often preclude seniors from getting necessary care to maintain a healthy quality of life. Another provision provides reimbursement for physician pathologists who provide the technical expertise in labs to identify diseases such as cancer in tissue samples.

The bill also recognizes that our rural pharmacists are important partners in the implementation of the Medicare Prescription Drug Plan and takes steps to ensure that they will survive and thrive for future generations of Arkansans. It provides for the prompt payment of reimbursements for pharmacists so they are not forced to take out loans to provide prescription drugs for seniors. Further, it delays implementation of the Centers for Medicare & Medicaid Services' Average Manufacturers Price (AMP) rule so that the reimbursement formula can be changed to more accurately reflect pharmacists' costs of dispensing prescriptions to low-income individuals.

Lastly, our bill makes needed reforms to the Medicare Advantage (MA) Program. The Administration's veto threat—and the Republican's obstruction—were due mainly to the proposed reforms to MA.

The MA program was developed by Congress to provide a federally subsidized alternative to regular fee-for-service Medicare. Private insurers entered the program maintaining that the efficiency and competitiveness of the private market would enable them to provide better coverage to Medicare beneficiaries at a lower cost. Although well-intentioned, these plans have not saved taxpayers money. In fact, they have done just the opposite. Of the five MA plan types available, the Medicare Advantage "private-fee-for service" plan, which this bill reforms, costs taxpayers, on average, about 20 percent more than traditional Medicare.

Further, I've had seniors complain to my office that, after signing up for these private-fee-for-service plans, they can no longer see their personal physician because these private insurers have not developed a network of providers. Some seniors signed up for these plans without understanding the details because of aggressive, and in some cases, unscrupulous marketing practices.

Many were unaware that by signing up for an MA plan, they would be getting out of regular Medicare altogether—sometimes because the insurance agent falsely advertised the MA plan as "supplemental" coverage to regular Medicare. Once seniors discover they made a mistake, it is often a long and arduous process to withdraw from the plan and get back into regular Medicare or another plan that meets their needs.

In this new Medicare reform bill, we are attempting to address these concerns. We require the MA private-fee-for-service plans to develop provider networks—like the other MA plan types are required to do—if they operate in an area where two or more MA plan types operate. We have taken steps to improve the oversight of sales and marketing of MA plans to bring accountability back to the process. When seniors sign up for the plans, they should know exactly what they are getting and whether their doctors actually accept that plan. We also require MA plans to report on quality measures so we know if we are getting good quality plans for our taxpayer dollars. Currently, MA plans offer no data to suggest they provide extra benefits or improve quality.

I understand that many seniors enjoy the choice and benefits that some MA plans provide. However, it is our job to look at what programs work and what programs fall short of our expectations. We have a responsibility to ensure that MA is cost-effective to taxpayers and fair for seniors.

President Bush has indicated that he will veto this bill. That is unfortunate. While I would prefer that he put his objections aside and sign this bill, it did pass both the House and the Senate with veto-proof majorities. Once this bill becomes law, millions of seniors and military families across this country will rest easier knowing that they can receive the care they have earned.

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